Why I Recommend a Coronary Calcium Score for Some of My Patients

One of the questions I get asked often is, “How do I know if I’m at risk for heart disease if I feel perfectly fine?”

The truth is that heart disease often develops silently for years before it causes symptoms. Many people feel healthy until they experience a heart attack or other serious cardiac event. That’s why, for the right patient, I often recommend a Coronary Artery Calcium (CAC) Score, also known as a Cardiac Calcium Score.

This is one of my favorite screening tools because it is quick, non-invasive, requires no IV, no needles, and usually takes less than 10 minutes. It uses a low-dose CT scan to look for calcium deposits in the arteries that supply blood to your heart. Those calcium deposits are a marker of plaque buildup, which can indicate coronary artery disease.

Who may benefit?

A calcium score is not for everyone. It is most helpful for patients who may have risk factors but are unsure how aggressive we should be with prevention.

Some examples include:

Family history of early heart disease

High cholesterol or elevated ApoB/Lp(a)

High blood pressure

Diabetes or prediabetes

Former or current smokers

Men over 40 and women over 45 with cardiovascular risk factors

Patients who are hesitant about starting cholesterol medication and want more information before making a decision

Sometimes a patient tells me, “I exercise, I eat well, and I feel great.” That’s wonderful, but unfortunately, plaque doesn’t always cause symptoms. A calcium score can help us look beneath the surface.

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Why I find it helpful

I don’t believe in prescribing medications simply because a guideline says so. I prefer making decisions based on the whole person.

A calcium score gives us another piece of the puzzle.

For someone with a score of zero, it can be reassuring. It often suggests a very low risk of a heart attack over the next several years (although it doesn’t eliminate all risk).

If the score is elevated, it tells us there is already evidence of plaque in the coronary arteries. That doesn’t mean a heart attack is imminent, but it gives us an opportunity to intervene early through lifestyle changes and, when appropriate, medications to reduce future risk.

I’ve also found that seeing an actual number often motivates patients. Diet, exercise, blood pressure control, smoking cessation, and cholesterol management become much more meaningful when patients understand what is happening inside their arteries.

What are the downsides?

Like any medical test, it’s important to understand its limitations.

A calcium score:

Does expose you to a small amount of radiation, although the dose is relatively low.

Does not detect soft (non-calcified) plaque.

Does not tell us whether a blockage is severe enough to require a procedure.

May lead to additional testing if significant calcium is found.

Is generally not recommended for very low-risk individuals or patients who already have known coronary artery disease.

This is why I don’t order it routinely for everyone. The goal is to use the right test for the right patient.

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My approach at Sunny Health DPC

One of the advantages of Direct Primary Care is that we have time to talk through these decisions together.

Rather than relying solely on age or a risk calculator, we consider your overall health, family history, lab results, lifestyle, and personal goals. If a calcium score would meaningfully change your treatment plan, then it’s a conversation worth having.

Prevention is always easier than treating a heart attack after it happens.

If you’re wondering whether a Coronary Calcium Score is appropriate for you, I’d be happy to discuss your individual risk and help you decide if it’s the right next step.

— Dr. Ga Geong Lee

Sunny Health DPC | Las Vegas